Basic Information
| Provider Information | |||||||||
| NPI: | 1104980820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHALIFA | ||||||||
| FirstName: | SUHA | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 W CHEW ST | ||||||||
| Address2: | PHYSICIAN ACCOUNTS | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107765100 | ||||||||
| FaxNumber: | 6106633113 | ||||||||
| Practice Location | |||||||||
| Address1: | 3570 HAMILTON BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181034512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104337481 | ||||||||
| FaxNumber: | 6104333991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD430371 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2808320000 | 01 | IBC | OTHER | 1937588 | 01 | HIGHMARK BLUE SHIELD | OTHER | 50065437 | 01 | CBC | OTHER | 1018626210001 | 05 | PA | MEDICAID | P008307 | 01 | GATEWAY HEALTH PLAN | OTHER |